Meg Hillier, chair of the PAC, said there are “serious flaws” in the government’s approach to staffing the NHS both in the present and the future, with no coherent attempt made to assess the headcount needed for a seven-day health service.
“It beggars belief that such a major policy should be advanced with so flimsy a notion of how it will be funded,” she said.
The government expects its commitment to provide an extra £10bn in funding for the NHS by 2020 to cover everything, including seven-day services, until the end of the decade.
Hillier said taxpayers were being asked to accept “uncosted” plans for a seven-day NHS – “plans which therefore present a serious risk to public money”.
The PAC said it was “far from convinced” that the department has any assurance that increase in funding will be sufficient to meet its policy objectives.
It highlighted severe drawbacks in the NHS’s staff management, leading to money wasted on agency workers, substantial staff shortfalls, and poorer quality services.
Pressure to meet unrealistic cost cutting targets imposed on NHS trusts by national bodies are leading to hospitals underestimating the number of staff they require, the MPs said. In turn, trusts are turning to agencies to get their headcount up to the necessary number.
Hillier said it was unacceptable for the government to blame the fees charged by staffing agencies for the growth in spending, when in fact “its own mismanagement” is a major contributor to the size of the bills.
Spending on agency staff increased by half from £2.2bn in 2009-10 to £3.3bn in 2014-15. The PAC stressed this was due to higher volumes of agency staff, not higher rates, as had been claimed by sources such as NHS England.
The PAC noted that, while retaining existing clinical staff is the cheapest and best way of ensuring a good supply, efforts to do so are not well managed.
Data suggests that within NHS hospitals and community healthcare, the proportion of nurses leaving increased from 6.8% in 2010/11 to 9.2% in 2014/15.
The government expects the shortage of nurses, caused by a reduced number of training places, a fall in the number of nurses recruited from within the European Union, and a poor rate of return to practice, to continue for the next three years.
The PAC added that the coordination of overseas recruitment of clinical staff has been poor, with some trusts potentially competing to recruit the same people.
MPs also highlighted the impact of proposed changes to funding for applicants looking to train as nurses, midwives and other health professionals.
Last autumn, chancellor George Osborne announced that bursaries for nurses would be scrapped in favour of student loans.
The PAC said the changes could have a negative impact on the overall number of applicants and particularly on certain groups, such as mature students or those with children.
Other issues that also concerned the PAC included limitations in the data on staffing pressures hampering informed decision making and the lack of affordable homes in some parts of the country, such as London, where nurses and healthcare assistants find it “virtually impossible” to live.
